As Big Pharma opioid settlement cash trickles into county coffers, officials turn to community for input
The first installment of the more than $26 million Santa Cruz County is due from a national settlement is in the county’s 2023-24 budget, and residents will be surveyed on how they’d like to see it spent.
This story was originally featured in this week’s In the Public Interest newsletter from Christopher Neely. Be the first to hear about politics and policy news in Santa Cruz County — sign up for Christopher’s email newsletter here.
The opioid crisis in Santa Cruz County
Lookout’s ongoing coverage of the toll of fentanyl and other opioids on Santa Cruz County, including efforts to end the stigma around addiction and to make overdose-reversal medications like Narcan more widely available in the community.
In 2016, at the height of the prescription opioid epidemic, Santa Cruz County tallied 35 opioid overdose deaths and 188,000 prescriptions, which, according to the county, was “enough to medicate every man, woman and child for six weeks continuously.” By 2018, much of the country understood that the villains of this crisis were the pharmaceutical companies and drug distributors, and they needed to be held accountable. Santa Cruz County, along with more than 3,000 jurisdictions across the United States, sought reparations and sued.
The companies, such as Janssen, CVS, Walgreens and Allergan, eventually relented in their effort to defend themselves and chose to settle. Now, five years later, that money is beginning to trickle into communities across the country. When the Santa Cruz County Board of Supervisors adopted its 2023-24 budget last Tuesday, its revenue included approximately $2 million in opioid settlement cash. It’s the initial payment of more than $26 million that the county expects to receive from the pharmaceutical companies over the next 18 years.
Unlike nearly every penny in the government’s budget, the county has not committed this initial $2 million to any specific use just yet. Instead — and contrary to most other jurisdictions that have already decided how to use the dollars — Santa Cruz County wants to know how county residents would spend it and is preparing to launch a process to mine community ideas.
A team at the county’s Health Services Agency (HSA) is developing a survey it expects to send out by July asking the community to weigh in on how the county should spend the millions. However, it’s not a completely open question, as the settlement agreement restricts jurisdictions to using the money on opioid crisis-adjacent programs, such as boosting the Narcan stock, preventative treatment and education.
The State of California, which is distributing the money to its jurisdictions, went a step further and is not only requiring that half the money be spent on programs that curb opioid use and addiction, but also that cities and counties report to the state on how they are spending the settlement dollars. Last week, HSA director Mónica Morales said staff was working with leaders in the county’s four cities to build a unified front against the opioid crisis.
These programs are top of mind in our area; the money is coming as the county experiences a resurgence in opioid-related overdoses and deaths. In her final public address last week ahead of her retirement, Dr. Gail Newel, the county’s public health officer, cited opioids as a worsening crisis in Santa Cruz County, and noted that Santa Cruz, Soquel and Boulder Creek outpaced the state average in opioid-related overdose deaths in 2021. In May, overdoses in the county hit their highest level in over a year. Lookout has been closely following the worsening local opioid crisis over the past couple years.
After the county collects responses through the survey, it plans to host a pair of town halls, likely around August and September, to hear any final thoughts from the community on how and where to spend the money.
Helpless response to homelessness
Santa Cruz County’s growing homelessness problem has been, in part, attributed to its position as one of the least affordable communities in the U.S. Now, the region’s high cost of living is also being cited as central to the government’s failure to properly address its homelessness crisis.
Chronic understaffing in the county’s Behavioral Health division has left its front-line homelessness and mental health response programs starved for resources, says the Santa Cruz County Civil Grand Jury in its latest report. According to the civil grand jury, — a 19-member, volunteer government watchdog mandated in all of California’s counties — more than one in four of the department’s positions were unfilled as of March 15. The jury found that crisis response teams, such as the Mobile Emergency Response Team, are “frequently understaffed by as much as 50%” and, although they have the funding, the lack of staff has left the program unable to expand to weekend coverage.
The jury, after interviewing county officials and employees, cited the “extremely high cost of living,” competition from private health care companies and wealthier counties offering higher pay, as well as the challenging size of the homeless population as critical to the behavioral health staffing shortage.
The homeless population, however, is far from the only group affected by Behavioral Health’s staffing shortages. The jury criticized the department’s poor outreach to the Hispanic community, due in part to depleted bilingual staff. It also urged the county to add more capacity to its crisis stabilization program, which offers services to patients experiencing mental health emergencies. More beds and seats in the program means less reliance on hospital emergency rooms where patients receive care but are then released with little follow-up.
Fixing this problem begins with incentives for the jobs left unfilled, according to the jury’s final recommendations. This means bumping up salaries and hiring bonuses, workforce tuition and loan repayment programs, partnerships with local colleges and talent pools, as well as annual studies on how competitive the county is as an employer compared to neighboring governments.
“Until the staffing level is significantly improved, expecting improved service in any of these areas is unreasonable,” the jury concluded.